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A. About Centurion
Centurion, LLC is a correctional healthcare company formed through a partnership between
Centene Corporation, a Fortune 100 Medicaid managed care company with 33 years of
managed care experience, and MHM Services, Inc., a national leader in providing healthcare
services to correctional systems with over 36 years of experience.
Centurion was also strategically developed to meet the healthcare challenges and needs of
correctional agencies with specific consideration to the tenets of federal healthcare reforms
(i.e., the Affordable Care Act), Medicaid, and the convergence of correctional healthcare with
the broader public health spectrum. Now more than ever, with continuous reforms occurring
to national healthcare programs, correctional agencies need the real managed care resources
and industry expertise to stay ahead of changes to healthcare funding and entitlement
programs that only a national managed care company can offer. Our unique managed care
resources have implications beyond just the healthcare delivered to inmates while
incarcerated. Our model integrates with the local public health systems resources so that
inmates are better prepared and better able to successfully manage their healthcare needs
after release. Our model is particularly well suited for county detention facilities that must
integrate with numerous other care organizations and service providers in the community.
Through its affiliation with MHM, Centurion has significant resources in Georgia, including two
regional offices and more than 300 employees in the state, giving the company a solid
foundation to support the operations of the Chatham County detention facility.
Centurion has reviewed a copy of the current medical services contract through an open
records request and understands the scope of services related to the medical, dental, and
mental health programs, including the staffing and ancillary service needs associated with the
overall healthcare program.
Centurion understands the jails current population is approximately 1,700 inmates and that
medical services are needed on a daily basis in the jails clinic areas, intake area, housing units,
and infirmary unit. Centurion understands the scope of services includes the development and
management of referral relationships with area hospitals and specialty service providers for
services that require the offsite transport of inmates (e.g., hospitalization, emergency room
trips, etc.).
Centurion understands the jail includes a 22-bed infirmary unit that operates 24/7 providing
housing and medical services for inmates who cannot be maintained in other housing areas due
to their medical condition.
Centurion will deliver services in compliance with local jail standards as well as the standards of
the Medical Association of Georgia (MAG), The American Correctional Association (ACA), and
the National Commission on Correctional Health Care (NCCHC). Centurion has experience with
supporting the accreditation processes of each of these organizations.
C. Staffing
Centurion has a basic understanding of the present staffing levels at the jail and the challenges
to date in being able to attract and retain qualified healthcare staff.
The staffing pattern above is based upon Centurions cursory review of the current staffing
pattern and Centurions understanding of the pressing needs and concerns regarding access to
services, timeliness of assessment and treatment services, and shortcomings within the mental
health program. The proposed staffing pattern provides more practitioner and mental health
coverage to the intake area of the jail while maintaining existing required staffing levels in other
areas of the facility. The proposed staffing pattern increases the number of medical providers,
namely mid-level providers (i.e., nurse practitioners, physician assistants, clinical nurse
specialists) as well as licensed mental health professionals to be able to provide 24/7 coverage
for intake assessments for both medical and mental health services. In addition, the proposed
staffing pattern increases psychiatric coverage over what is understood to be the present
coverage level.
Centurion will fill the above positions with qualified professionals retained as employees of the
company and offer employees competitive wages and benefits as well as other valuable
employee supports.
In addition to the above positions, Centurion will provide a physician consultant for an
Infectious Disease Management program. Centurion also understands there is a current
relationship between the current medical contractor and a local Federally Qualified Health
Center (Curtis V. Cooper) for 340B medication services.
Centurion will give first consideration to incumbent employees in the above positions who are
in good standing with the County and wish to remain in their positions. Any remaining
positions will be filled with qualified candidates generated through our recruiting processes.
D. Program Management
Centurion will designate a full-time Health Services Administrator based in Savannah to serve as
the local manager of the program and serve as the primary point of contact for the County on
the day-to-day operations of the jail medical contract. This individual will be dedicated solely to
the Chatham County Jail program and serve as the primary liaison with jail and County
personnel, as well as other local stakeholders, regarding the jail medical program.
Centurion will provide clinical leadership to the program at a local level via a full-time physician
medical director and full-time director of nursing. These individuals will be based in the jail and
dedicated to the Chatham County Jail medical program.
E. Recruiting
Centurion has the flexibility in our recruiting and retention packages to customize our searches
for each position and tailor compensation packages to attract qualified candidates in todays
difficult healthcare recruiting environment. Centurion will be able to attract and retain
qualified clinicians to stabilize the jails staffing patterns so that consistent coverage is provided.
Contract monitoring
Accreditation support (e.g., ACA, NCCHC)
Program development
Training and continuing education
Case consultations
Psychotropic medication utilization review and management
Clinical guidelines development and prescriber training
Litigation management / avoidance
Clinical Operations team members routinely visit contract locations to perform quality
and compliance audits, provide training programs, and work with the client agencies on
developing programming enhancements and clinical guidelines for treatment.
3. Mental Health Services: Because of the companys affiliation with MHM Services, Inc.,
Centurion is able to offer superior mental health programming and clinical operations
expertise. MHM is a national leading provider of mental health services and has been
providing mental health services in Georgia for 20 years through its contract with the
Georgia Department of Corrections. MHM is also the contract mental health provider
for the DeKalb County Jail in Atlanta (since 2000). Centurion will engage the resources
and clinical operations support from MHMs team of nationally recognized experts in
correctional mental health services.
5. Telehealth: Centurion will advance the use of telehealth technology to help minimize
the transport of inmates offsite for healthcare services (e.g., for specialists consults).
Telehealth services will accentuate the level of services provided on site.
Centurion invests in new contract startups to ensure successful transitions with no lapses in
care. We dispatch large teams of correctional healthcare managers and clinical experts to be
physically present and on site during the transition of each new contract. We use a high-touch,
high-visibility approach to rapidly transition employees and clinical services.
Centurion will give first consideration to any existing personnel whose positions are affected by
this project and who wish to remain in their positions, and are in good standing with the
County.
Often during contract transitions, there are negative rumors and false information that create
anxiety among existing staff. Centurion takes steps to minimize this situation by being available
in person in the facility to meet directly with staff to address any questions or concerns. We
also prefer disseminating an immediate written correspondence in the form of a general
welcome letter that introduces Centurion to employees and stakeholders, and provides
immediate contact information for stakeholders to reach out to Centurion.
Our transition team will consist of our Georgia regional leadership, as well as other clinical and
human resources personnel necessary to ensure live availability at the jail and after-hours
access for staff and others who may have questions or concerns during the transition.
We already have a database of personnel and candidates to source from for the Chatham
facility to fill the additional positions proposed in the staffing plan above, plus to fill any
vacancies that may occur during the transition.
Centurions transition plan assumes a target contract start date of October 1, 2017, but can be
modified to fit any actual start date. Centurion recognizes the urgent nature of the present
circumstances and the need to be poised to transition the contract under compressed time
constraints. In anticipation of the project, we are already taking steps to prepare for the
transition. The following table outlines basic activities to occur upon notification of award and
as part of the initial transition and start-up process:
Activity Comments
Initial team meeting Day 1. A meeting between Centurion and the
County to discuss start-up plan and transition
activities.
Throughout the transition, Centurion personnel will be highly visible and available to the jail
administration, the medical personnel, and other stakeholders.
Pharmacy Services and Network Development: At this point in time, Centurion has not had
any contact or dialogue with the existing pharmacy subcontractor or other entities or
stakeholders who are involved in the provision of services to jail detainees (i.e., hospitals,
specialists, community mental health centers, etc.). Centurion would initiate dialogue with
such entities immediately upon a notification to proceed from the County or as part of the
startup of an official contract for services.
H. Contracting Method
Centurion understands the urgent nature of the present circumstances regarding the medical
services program at the Chatham County Jail. Centurion is amenable to providing the services
described herein via a direct contract with the County, including an emergency contract of a
shorter duration than customary if necessary. Centurion understands that, if an emergency
contract is awarded, the County will be required to conduct a future competitively bid
solicitation to comply with County procurement rules.
For example, we believe that once the jail has a dedicated full-time medical director and a full-
time midlevel in R&D, that there may no longer be the need for another mid-level provider in
the jail. In addition, the staffing pattern has two masters-level individuals in R&D 24/7, a
midlevel (such as an NP), and a masters level LPC. Centurion is not sure that all would be
needed 24/7 and believes it may be possible to eliminate the LPC on certain shifts. Therefore,
once Centurion has received the necessary data to get a firm price (as described in the
Compensation section below), it is open to revisiting the staffing matrix. It is common for
Centurion to operate in new contracts and make adjustments to staffing and pricing after
approximately six months of operation.
Centurion is amenable to exploring various reimbursement options with the County to ensure
the lowest cost for services.
Six-month reconciliation. Centurion also understands the County may offer an opportunity to
revisit the terms and expenses of the contract after an initial six-month period to review the
effectiveness of the staffing patterns proposed and the contract reimbursement rate.
Centurion believes this review would allow us to make adjustments to staffing and services that
could lower the cost of services.
Indemnification. Centurion has read the indemnification language contained in the Countys
agreement with the current medical contractor, and Centurion is amenable to similar
indemnification language for any future contract between Centurion and the County.
I. Compensation
Centurion has priced only the staffing pattern listed in the table in Section C above using market
compensation rates and other overhead assumptions. The monthly reimbursement rate for the
staffing and administration of the jail medical, dental, and mental health programs is:
Monthly Reimbursement
$508,312
Offsite and ancillary services: The above amount does not include any costs for offsite
medical services (i.e, hospitalization, emergency room visits, specialty care) or services
provided on site by specialists. Centurion would need additional information, including
historical utilization and costs to be able to generate estimates of costs and pricing for
these services as well as an opportunity to hold dialogue and negotiations with hospital
and specialty service providers.
County Budget Considerations and Financial Risk: Centurion understands the County
currently has budgeted approximately $7.2 million for FY18 for the medical services
contract. The pricing quoted above approximates $6.1 million annualized, and
represents costs for the on-site staffing and management of the program.
Centurion understands the Countys current contract with Correct Health is based upon
a full-risk model, under which the Contractor bears all financial risks for offsite care,
specialty care, medications, staffing, and other costs. While Centurion believes the
Countys budget may be sufficient to meet acceptable standards for inmate healthcare
services, a firm price for all services from Centurion would require a review of historical
utilization trends as well as a process of negotiations with offsite service providers (i.e.,
hospitals, specialists) and the pharmacy vendor.
Centurion has no information at this point reflecting the utilization levels for offsite
medical services, specialty services, or pharmacy utilization and drug spend upon which
to build cost assumptions for pricing.
Penalties: Centurion understands that a fully functioning health care system requires
ensuring full staffing. Centurion expects that there will be penalties associated with
unfilled positions. Centurion requests a 90-day grace period before staffing penalties
are assessed in order to give time to address the operational and staffing shortcomings
inherited upon contract startup.
Price Contingencies: As stated above, Centurion has not made any contact at this point
with local hospitals, specialists, or the current pharmacy provider to discuss historical
utilization or to negotiate pricing. Should the County desire to move forward with
Centurion, we would be able to generate additional cost and pricing assumptions for
offsite and pharmacy services towards a mutually acceptable pricing and contracting
structure after dialogue with potential subcontractors for these services. Any final, firm,
fixed price quote from Centurion would be contingent upon an opportunity to review
historical utilization trends as well as a process of negotiations with offsite service
providers (i.e., hospitals, specialists) and the pharmacy vendor.
Inquiries
Mike Brewer
Sr. Vice President, Development
Centurion, LLC
1593 Spring Hill Road, Suite 600
Vienna, VA 22182
Phone: (571) 232-4327
Email: mbrewer@CenturionManagedCare.com